Gallstones/Cholecystectomy

A gallstone, is a lump of hard material usually range in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.

Types and causes of gallstones

Cholesterol stones

Pigment stones

Mixed stones - the most common type. They are comprised of cholesterol and salts

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by liver through bile. They include the following

Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as me

Obesity. Obesity is a major risk factor for gallstones, especially in women

Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides

Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones

Symptoms

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.

Symptoms may vary and often follow fatty meals, and they may occur during the night.

Abdominal bloating

Recurring intolerance of fatty foods

Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours

Pain in the back between the shoulder blades

Pain under the right shoulder

Nausea or vomiting

Indigestion & belching

Diagnoses

Ultrasound is the most sensitive and specific test for gallstones.

Other diagnostic tests may include

Computed tomography (CT) scan may show the gallstones or complications

Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope--a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts

Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice

Course of illness

Bile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.

Complications

The obstruction caused by gall stone may lead to Biliary colic, Inflammation of gall bladder (Cholecystitis) . Other complications may include

Pancreatitis – Inflammation of pancreas gland cause by passage /slippage of gall stone out of the gall bladder thru the common bile duct

Jaundice / Cholangitis: is an infection of the common bile duct cause by blockage from gall stones

Treatment

Surgery

Standard Laparoscopic Gallbladder Surgery

Scarless Laparoscopic Gallbladder Surgery

Standard Laparoscopic Surgery

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.

If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.

Scarless Laparoscopic Gallbladder Surgery

Single incision laparoscopic surgery (SILS) is a scarless surgical technique used to remove diseased organs through just one hole in the belly button. This includes:

Gall bladder removal (cholecystectomy)

Appendix removal (appendectomy)

The concept builds on laparoscopic/keyhole surgery, which has been used routinely since the 90s. Standard keyhole surgery involves several small incisions (usually 3 to 4). The single port surgical technique allows us to do the same procedure we’ve been doing for the past 15 years, but through a single incision in the umbilicus (belly button), thus leaving no new visible scar.

How the procedure is done. The new technique involves making an incision through the navel and inserting a port with multiple channels, so that instruments, including a miniature camera, can be fed through to the site of the operation, all through the one access point to remove the organ through a small incision in the navel (belly button). Once the procedure is finished, the surgeon folds the belly button back into its normal shape, leaving no visible scar.

The goal is to reduce postoperative pain, speed recovery and improve the aesthetic results for patients.